A Guide to Drug Detox

Detox is the process of eliminating the intoxicating substance – alcohol, illegal street drugs, or prescription drugs – from the body. This process reduces the tolerance the individual has developed to the intoxicating substance and ends their physical dependence on the drug. Detox, however, does not end addiction, because this is a disease of the mind that often involves cravings for the substance, even after the person has gone through the withdrawal process. While detox is an important first step in recovery, it must be followed by therapy.

Detox Basics

Detox is, primarily, withdrawal from taking an intoxicating substance. For many people, this leads to physical symptoms of withdrawal, as the body adjusts to functioning without the drug’s effects on the brain. Detox is an important step in the rehabilitation process, but it is not the same as rehabilitation; addiction is not over just because the person has gone through withdrawal from the substance.

In some cases, such as long-term alcohol abuse, withdrawal can have physically dangerous symptoms, like seizures or severe dehydration. It is important for people who want to detox to get medical help. A doctor’s oversight can ease cravings, reduce the risk of relapse, and ensure that the process is safe.

Withdrawal Symptoms

Different substances have different withdrawal symptoms, and detox from specific drugs involve varying withdrawal timelines. Some of the most common substances of abuse and their withdrawal symptoms are listed below:

Alcohol: When a person struggles with alcohol abuse or addiction and attempts to stop drinking, withdrawal symptoms typically begin within eight hours after the last drink. The most common withdrawal symptoms last up to 72 hours, but can continue for several weeks. Symptoms include mood swings, depression, nightmares, shakiness or jumpiness, loss of appetite, gastrointestinal distress, clammy skin, headaches, and sweating.Alcohol can be very dangerous to withdraw from alone due to a condition called delirium tremens, or alcohol withdrawal syndrome. Confusion, rapid heartbeat, fever, and even seizures are symptoms of DTs, which is estimated to affect 1-5 percent of individuals attempting to withdraw from alcohol after a period of sustained abuse.

Opioids: Symptoms of opioid withdrawal, whether from hydrocodone abuse or heroin addiction, are similar. They include anxiety and agitation, muscle aches, insomnia, runny eyes and nose, excessive yawning, sweating, diarrhea, abdominal cramps, goosebumps, and dilated pupils. These symptoms typically begin 12 hours after the last dose, although larger doses or longer-acting opioids like methadone or fentanyl can take longer to begin to clear the system. The most intense symptoms will peak after 72 hours, and withdrawal can last up to two weeks. Cravings and psychological withdrawal symptoms can last for months, however, and without help from doctors and therapists, the individual can relapse. This puts the person at risk of overdosing, because their body is no longer used to the same dosage levels of the drug.

Cocaine: Onset of cocaine withdrawal symptoms begins within a few hours after the last dose. Symptoms of the initial phase of cocaine withdrawal include exhaustion, oversleeping, depression, increased appetite, restlessness, and irritability. Phase two, the primary stage of withdrawal, peaks between one week and 10 weeks. Symptoms include lethargy, anxiety, strong cravings, ongoing depression, lack of concentration, and erratic sleep. The final phase of cocaine withdrawal, roughly 28 weeks after the final dose, includes some intermittent depression and cravings, but physical symptoms have ended. Still, without support from a rehabilitation program, therapy, or a medical professional, cravings commonly lead to relapse.

Benzodiazepines: Benzodiazepines like Xanax and Valium are used to treat anxiety, panic disorders, and, sometimes, insomnia and seizure disorders. People can become addicted to the calming effects of these drugs and begin to take large doses to experience euphoria and calm. Benzodiazepine withdrawal symptoms are often similar to the symptoms of the diseases the drug is designed to treat, so people withdrawing from these medications can experience insomnia, anxiety, panic attacks, and even seizures. The first phase of benzodiazepine withdrawal begins 1-4 days after the final dose. The second phase, which is considered “full-blown” withdrawal, peaks between 10 and 14 days after the final dose. The second phase is the most physically dangerous.

While the physical symptoms of withdrawal in some cases may not be physically dangerous, the primary concern with detoxing alone, at home, is the lack of support available. When a person is alone, they are more likely to relapse. Once their tolerance to a drug has decreased, relapse can lead to overdose more quickly. Even without overdose though, relapse means that the person has not overcome their addiction and can continue to spiral in this way, which can be psychologically damaging.

People who have become physically dependent on intoxicating substances can face serious physical problems, in addition to cravings. Delirium tremens and benzodiazepine withdrawal syndrome are both physically dangerous, and they can be life-threatening. If a person has a physical dependence on other drugs at very high doses, they can experience heart problems, seizures, and other serious conditions that can lead to long-term health consequences. As a result, medical detox is generally recommended.

Get Help to Detox

The best method for overcoming addiction to any substance, whether it is alcohol, heroin, stimulants, or other drugs, is to talk to a medical professional first. A doctor can help the person come up with a treatment plan to safely withdraw from the substance. In most cases, this can involve tapering the medication over time. Typically, tapering takes longer “cold turkey” withdrawal, but it is much safer.

A doctor can also prescribe small doses of medications like antidepressants or anti-anxiety medications that ease withdrawal symptoms. Some drugs, such as heroin or opioid painkillers, have medications that can be used specifically to help withdraw from the substance of abuse. In the case of opiates, these drugs are methadone, buprenorphine, and Suboxone, a combination of buprenorphine and naloxone. Buprenorphine-based medications bind to opioid receptors to ease the person’s cravings, without getting the person “high,” and they are believed to have less potential for abuse than methadone. The prescribing doctor will work with the patient to taper the buprenorphine or Suboxone dose over time, while monitoring the individual for symptoms of addiction. While the person is on medication, they should also be undergoing therapy to address the issues that led to the initial substance abuse.

Again, detox is not rehabilitation. It is not a magic cure for addiction; it must be followed by a comprehensive addiction treatment program. A doctor can help the person find a rehabilitation program, whether inpatient or outpatient, that will offer social support and therapy to overcome addiction. Therapy will help the person learn better coping strategies for stress and cravings, so they can learn to manage the disease.